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Unit 2 Draft (Adding a Section to Antidepressant)
Adherence
[edit]See also: Adherence (medicine)
Medication adherence is defined by the World Health Organization (WHO) as how closely patients follow the instructions given by their practitioner. The WHO estimates that worldwide, 40-70% of patients prescribed antidepressant medications do follow their practitioner's instructions.[1] In the United States, it is predicted that up to 50% of patients do not take their antidepressants as directed by their practitioner.[2]
Adherence Measurement Tools
[edit]Adherence is primarily measured through tracking pharmacy refill data and administering patient questionnaires. Quantitative measurement tools include:[3]
Medication Possession Ratio
[edit]The Medication Possession Ratio (MPR) tracks adherence using prescription refill data. MPR is an expression of the percentage of time that a patient has medication available, but does not take into account whether or not a patient is taking their medication correctly. This can often lead to an overestimation of adherence.
Proportion of Days Covered
[edit]Proportion of Days Covered (PDC) is another expression of the percentage of time that a patient has medication available. By accounting for patients refilling their medication early, PDC can provide a clearer representation of adherence. Much like MPR, PDC still does not account for whether or not medication is being taken properly.
Barriers to Adherence
[edit]The WHO groups barriers to antidepressant adherence into five categories; health care team and system-related factors, social and economic factors, condition-related factors, therapy-related factors, and patient-related factors. Common barriers include:[4]
| Barrier | Category |
|---|---|
| Poor Patient-provider Relationship | Health Care Team and System |
| Inadequate Access to Health Services | Health Care Team and System |
| High Medication Cost | Social and Economic |
| Cultural Beliefs | Social and Economic |
| Level of Symptom Severity | Condition |
| Availability of Effective Treatments | Condition |
| Immediacy of Beneficial Effects | Therapy |
| Side Effects | Therapy |
| Stigma Surrounding Disease | Patient |
| Inadequate Knowledge of Treatment | Patient |
Implications of Non-Adherence
[edit]Widely studied implications of non-adherence are clinical and economic in nature. Common clinical implications include greater risk for relapse and hospitalization, increased symptom severity, and reduced remission rates. Common economic implications include higher medical and total healthcare spending.[5] Less studied implications include reduced communication with the provider, increased use of sick leave, and decreased productivity.[6] It is estimated that medication non-adherence is responsible for up to 69% of all hospitalizations in the United States. The total cost of medication non-adherence on the United States healthcare system is estimated to be $100 billion per year.[5]
Solutions to Non-Adherence
[edit]Researchers have developed many solutions to help improve adherence, with most utilizing a therapeutic, technological, or communication approach. Proposed solutions include:
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| Adherence Method | Approach | Findings |
|---|---|---|
| Use of Newer Therapies[7] | Therapeutic | Patients using newer third generation therapies have been found to be more adherent than patients using first or second generation therapies. Researchers attribute this to increased efficacy and tolerability associated with newer agents. |
| Use of Consistent Therapy[8] | Therapeutic | Patients who remain on a higher dose of their initial therapy have been found to be more adherent than patients who begin combination therapy, or switch to an entirely new therapy. |
| Use of Reminder Devices[9] | Technological | Reminder devices, such as pillboxes, digital timer caps, pill bottle strips, and control arms, have not been shown to result in higher antidepressant adherence rates. |
| Motivational Interviewing[2] | Communication | Practitioners that engage in motivation interviewing have been found to have higher adherence rates amongst patients, compared to those who did not. |
| Treatment Initiation and Participation (TIP) Intervention[10] | Communication | TIP intervention involves the practitioner reviewing symptoms and conducting a barriers assessment, defining patient goals for adherence, providing education about the disease and medication, addressing barriers to treatment, and creating an adherence strategy. Patients who received TIP intervention at the start of therapy have been found to be more adherent than those who did not. |
- ^ "Adherence to Long Term Therapies: Evidence for Action" (PDF). World Health Organization. 2003.
- ^ a b Kaplan, Jessica E.; Keeley, Robert D.; Engel, Matthew; Emsermann, Caroline; Brody, David (July 2013). "Aspects of patient and clinician language predict adherence to antidepressant medication". Journal of the American Board of Family Medicine: JABFM. 26 (4): 409–420. doi:10.3122/jabfm.2013.04.120201. ISSN 1558-7118. PMID 23833156.
- ^ "Do You Know the Difference Between These Adherence Measures?". www.pharmacytimes.com. Retrieved 2018-02-26.
- ^ "Adherence to Long-Term Therapies - Evidence for Action: Section II - Improving adherence rates: guidance for countries: Chapter V - Towards the solution: 1. Five interacting dimensions affect adherence". apps.who.int. Retrieved 2018-02-26.
- ^ a b "Clinical and economic impact of non-adherence to antidepressants in major depressive disorder: A systematic review". Journal of Affective Disorders. 193: 1–10. 2016-03-15. doi:10.1016/j.jad.2015.12.029. ISSN 0165-0327.
- ^ "Impact of initial medication non-adherence to SSRIs on medical visits and sick leaves". Journal of Affective Disorders. 226: 282–286. 2018-01-15. doi:10.1016/j.jad.2017.09.057. ISSN 0165-0327.
- ^ Sheehan, David V.; Keene, Matthew S.; Eaddy, Michael; Krulewicz, Stan; Kraus, John E.; Carpenter, David J. (2008). "Differences in medication adherence and healthcare resource utilization patterns: older versus newer antidepressant agents in patients with depression and/or anxiety disorders". CNS drugs. 22 (11): 963–973. ISSN 1172-7047. PMID 18840035.
- ^ "Increasing escitalopram dose is associated with fewer discontinuations than switch or combination approaches in patients initially on escitalopram 10 mg". European Psychiatry. 27 (4): 250–257. 2012-05-01. doi:10.1016/j.eurpsy.2010.08.009. ISSN 0924-9338.
- ^ Choudhry, Niteesh K.; Krumme, Alexis A.; Ercole, Patrick M.; Girdish, Charmaine; Tong, Angela Y.; Khan, Nazleen F.; Brennan, Troyen A.; Matlin, Olga S.; Shrank, William H. (2017-05-01). "Effect of Reminder Devices on Medication Adherence". JAMA Internal Medicine. 177 (5). doi:10.1001/jamainternmed.2016.9627. ISSN 2168-6106.
- ^ Sirey, Jo Anne; Banerjee, Samprit; Marino, Patricia; Bruce, Martha L.; Halkett, Ashley; Turnwald, Molly; Chiang, Claire; Liles, Brian; Artis, Amanda (2017-11-01). "Adherence to Depression Treatment in Primary Care". JAMA Psychiatry. 74 (11). doi:10.1001/jamapsychiatry.2017.3047. ISSN 2168-622X.
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Article Evaluation: Independent Pharmacy 1.)Is everything in the article relevant to the article topic? Is there anything that distracted you? All of the information included in this article is relevant to independent pharmacy practice. The incorporation of insurance practices in the section about Independent Pharmacy in Rural America did serve to be a bit distracting. 2.)Is the article neutral? Are there any claims, or frames, that appear heavily biased toward a particular position? The only somewhat biased statement appears to be "Independent pharmacy owners generally have high standards of customer service and strive to outperform chain pharmacy competitors." This can possibly imply that pharmacists outside of independent pharmacy are somewhat inferior. 3.)Are there viewpoints that are overrepresented, or underrepresented? Information about what makes independent pharmacies special appears to be heavily represented through including positive survey results, but potential drawbacks to using an independent pharmacy are not addressed. 4.)Check a few citations. Do the links work? Does the source support the claims in the article? The citation links do work, and the sources support the claims made in the article. 5.)Is each fact referenced with an appropriate, reliable reference? Where does the information come from? Are these neutral sources? If biased, is that bias noted? Many of the facts come from independent survey organizations, and thus can be considered relatively neutral. 6.)Is any information out of date? Is anything missing that could be added? Most of the information appears to have come from sources that have been published after 2010, meaning they are fairly up-to-date. The article could benefit from the addition of criticism and drawbacks associated with an independent pharmacy. 7.)Check out the Talk page of the article. What kinds of conversations, if any, are going on behind the scenes about how to represent this topic? There is no activity on the article's talk page. 8.)How is the article rated? Is it a part of any WikiProjects? The article is rated as "stub-class," and is part of the business WikiProject. 9.)How does the way Wikipedia discusses this topic differ from the way we've talked about it in class? Overall, the presentation and discussion of this topic is fairly consistent with the way discussed in class.